Target value tailored (TVT) apheresis approach for blood progenitor cell collection after high-dose chemotherapy and rh-G-CSF.

Twenty-eight patients with different hematological diseases (17 non-Hodgkin's lymphoma, one Hodgkin's disease and 10 multiple myeloma) underwent peripheral blood progenitor cell (PBPC) collection after cyclophosphamide 7 g/m2 and rh-G-CSF. Fifty-eight leukaphereses were carried out with a fully automated PBPC collection procedure. Progenitor cell release was monitored by standardized determination of CD34+ cells in the peripheral blood. After a profound aplasia, a continuous increase in CD34+ cells in the peripheral blood was seen for at least 3-4 days. In 82% of our patients more than 2.5 x 10(6) CD34/kg could be collected using a standard apheresis of 10 l. There was a high correlation between the CD34+ cells in the peripheral blood and CD34+ cells/kg harvested. (r2 = 0.91). A relatively constant ratio (median 14.3, range 3.2-22.6) was found between CD34+ cells/kg and CFU-GM/kg. Based on the CD34 values of the pre-apheresis blood and the body weight of an individual patient and using the mathematical model of regression analysis (y = mx + b) for the correlation between the CD34+ cells/microliter in the pre-apheresis blood and the CD34+ cells/kg, it was possible to create a formula allowing for target value tailored apheresis. Using this formula, the blood volume which needs to be processed in order to harvest a desired number of CD34+ cells/kg can be calculated. This strategy can be applied to reduce the time for and the number of aphereses. Nineteen leukaphereses were carried out applying the formula. In 18 of 19 leukaphereses the expected CD34+/kg values were correctly achieved or exceeded. The formula was most reliable when the CD34 value was higher than 15/microliter and when the WBC count was below 20 x 10(9)/l in the pre-apheresis blood. For mobilizations using hematopoietic growth factors alone our formula is not applicable, because in most cases the pre-apheresis white blood cell count is higher than 20 x 10(9)/l and the collection efficacy of lymphomonocytoid cells decreases with a high pre-apheresis white blood cell count. The formula also works with other mobilization regimens that induce a pronounced aplasia.

[Hemolytic anemia and renal insufficiency caused by nomifensine. Description of a case]. / Anemia emolitica e insufficienza renale da nomifensina. Descrizione di un caso.

A 38 year old patient suffered two haemolytic attacks with kidney failure following treatment with Nomiphensin (Psicronizer). The second haemolysis was only preceded by 50 mg Nomiphensin after prolonged suspension of treatment with the drug. Blood tests revealed the autoimmune nature of the haemolytic process and demonstrated the close connection with Nomiphensin intake. The personal results are compared with those of the series published earlier.

Emergency splenectomy in hairy cell leukemia.

The role of splenectomy in the treatment of hairy cell leukemia (HCL) is now well established. There are however some particular situations which indicate splenectomy as a possible emergency therapy in markedly cytopenic cases with severe antibiotic-resistant infections. The aim of the emergency splenectomy in such conditions is to temporarily increase neutrophils and to permit the improvement of the infectious disease. We describe 2 cases of HCL with severe infectious disease, successfully splenectomized.

Cytobiological and clinical aspects of tissue mast cell leukaemia.

The authors describe the results of a series of cytochemical, autoradiographic, cytophotometric and immunological investigations carried out in a case of tissue mast cell leukaemia. Leukaemic mast cells showed certain distinctive cytochemical features, amongst which an intense periodic acid-Schiff (PAS) reaction, sensitive to amylase digestion, strong naphthol AS-D chloroacetate esterase (NASDCE), intense lactate dehydrogenase (LD) activity. Proliferative activity, determined autoradiographically with 3H-dT, was considerably low and was mainly confined to the larger cells. Also uridine and leucine incorporation were markedly reduced. Microdensitometry disclosed that the mast cell population was mainly arrested in the G1 phase. Because of previous attempts to destroy selectively neoplastic tissue mast cells with sheep antihuman IgE serum, a search for surface bound IgE was carried out, but gave a negative result. Possible therapeutic approaches are considered in the light of previous clinical experience and on the basis of the results of the kinetic and metabolic studies.

Classical factor X deficiency. Report of a further case.

A case of classical factor X deficiency is reported. The propositus is a 28-year-old male who presented easy bruising, epistaxis, hematomas, hematuria and occasional hemartrosis since early childhood. The severely prolonged prothrombin time was corrected by normal serum but not by adsorbed normal plasma. The abnormality was not corrected by the plasma of a patient with factor X deficiency, but by the plasma of patients with factor II or VII deficiencies. Partial thromboplastin time, prothrombin consumption and the thromboplastin generation test were abnormal. The thromboelastogram showed a prolonged 'K' and 'r' together with a normal 'ma'. Factor X was very low (smaller than 1%). Platelet tests were normal. No factor X band or precipitates were seen on electroimmunoassay and on the cross-over electrophoresis. The non-consanguineous parents and several other members of the family were found to be heterozygotes.